6 Sneaky Signs Of Lung Cancer That Have Nothing To Do With A Cough

You probably think of lung cancer as a smoker's disease—after all, we've long heard the warnings that lighting up skyrockets your risk. And while that’s certainly true, the truth is, it's not exclusively a smoker's disease.

And the number of non-smokers who develop the deadly disease may be rising: In fact, in a study of 2,170 lung cancer patients from Europe, the frequency of never-smokers developing lung cancer more than doubled from 2008 to 2016.

The American Cancer Society estimates that as many as 20% of annual lung cancer deaths are in people who've never smoked or used tobacco. That's more than 30,000 of the estimated 155,870 lung cancer deaths in 2017—more than colon, breast, and prostate cancer deaths combined. (Overall, there were about 222,500 new cases of lung cancer in 2017.)

Yes, it's still true that smoking is the biggest risk factor, but it's not the only one. "You may be exposed to things that cause lung cancer and not even know it," says Raja Flores, MD, chief of thoracic surgery for the Mount Sinai Health System. For instance, you may have been around radon gas, carcinogens like asbestos, or secondhand smoke, he says—maybe you lived next to a neighbor who smoked inside for years, or you used to tear down walls in the construction business.

If you recognize any sneaky risk factors, it's particularly important to be aware of the signs of lung cancer. Unfortunately, symptoms often don't show up until the cancer is in an advanced stage, which is why it's often caught late in the game (and much harder to treat, since it's often spread to other parts of the body).

In fact, that’s one reason why lung cancer is so deadly. Only 18% of people diagnosed with it survive five years or longer, according to the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER).

But that doesn't mean it can't be cured—the goal is to catch it as soon as you can.

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"It's very aggressive, so when you catch it early, you have to act on it early," says Flores.

That means you have to know the signs and symptoms of lung cancer—whether you smoke, have smoked in the past, or have never lit up even once (And if you still smoke, here's how to quit for good).

Cough, of course, is probably the lung cancer sign you think of right off the bat, and for good reason: It’s the most common symptom of lung cancer, according to a study in the journal Thorax, which found 65% of lung cancer cases included it.

A persistent cough could be the result of a tumor obstructing your airway, which triggers your cough reflex, says Flores. It’s even more concerning as a cancer sign if it’s accompanied by blood or rust-colored phlegm. As cancer cells invade your lungs, the healthy tissue experiences some shedding and irritation, which is where the blood that's coughed up comes from, he explains.

Lung cancer sign: Hoarseness

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A hoarse, raspy, or weak voice can be another indicator of lung cancer.

"There's a nerve called the recurrent laryngeal nerve that goes between your trachea and esophagus and under your aorta," says Flores. It connects to your larynx (which houses the vocal cords), and if a tumor is pressing on this nerve, it can become paralyzed.

"[This means] your vocal cords don't close, and you need your vocal cords to close to be able to cough, sing, and speak," says Flores. He notes that hoarseness can also be a symptom of vocal cord cancer—which is also associated with smoking.

Lung cancer sign: Shortness of breath

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Shortness of breath can indicate that there's a blockage—say, a tumor—preventing you from getting enough air into your lungs. But it can also be a sign of an accumulation of fluid between your lungs and your chest wall.

This happens when the cancer invades your lymphatics and venous structures, which are responsible for allowing fluid to leave your chest, Flores says. If there's a blockage in these areas, fluid won't be able to drain, leading to buildup.

"It's called a pleural effusion—you're going to feel like you're not getting enough air into your lungs, because the fluid is pushing on the lung and not allowing it to expand," says Flores.

Lung cancer sign: Multiple pneumonias

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Multiple bouts of pneumonia should raise a big red flag that something is up, says Flores. When cancer blocks the smaller airways in the lungs, it creates a breeding ground for bacteria to multiply, which can lead to an infection.

Lung cancer can also cause several syndromes that seem unrelated to the lungs.

Cancers in the top part of your lungs can press on nerves leading to your eyes and face, which may cause a drooping eyelid, a smaller pupil, or reduced sweating on one side of the face. This is called Horner syndrome.

Tumors that press on the superior vena cava—a large vein that passes next to the upper part of the right lung—can cause a backup of blood. The result? Swelling in your face, neck, arms and upper chest, as well as headaches and dizziness, according to the American Cancer Society.

Some lung cancers also secrete hormone-like substances that affect other organs—these are called paraneoplastic syndromes, says Flores. Depending on the specific syndrome, they can have vast hormonal effects, from weight gain to fatigue to gynecomastia, or male breast growth.

However, he estimates that these occur in fewer than 2% of lung cancers, and it's unlikely that these syndromes would lead you to lung cancer.

When to get these lung cancer symptoms checked out

If you're experiencing any one of these symptoms for more than a month, it's time to get checked out.

"All it takes is a little CT scan," says Flores. Your doctor may also want to do a bronchoscopy, a procedure where they look at your airways through a thin tube.

But don’t freak out. In the vast majority of the cases, lung cancer won’t be the cause of the symptoms. And the younger you are, the more likely it is that these symptoms are caused by non-cancer causes—say, acid reflux conditions like GERD can cause hoarseness, while asthma (which you can develop as an adult) can cause wheezing. In fact, 91% of all lung cancer cases are diagnosed in people 55 or above, according to SEER data.

"Most of the time, they won't find anything," says Flores. But if there is cancer to be found, getting checked out as soon as possible makes it more likely that you'll catch it at a treatable stage.

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